By Laura Maggi
and Kate Moran
Staff writers
Willie Lewis had been home from Touro Infirmary for less than 10 minutes when he pulled out a pocketknife and repeatedly stabbed his 77-year-old mother in the driveway of their Uptown home.
From a hospital bed, his mother would tell police that Lewis, 40, was a paranoid schizophrenic who had been off his medication for months. Although he let the New Orleans police officers bring him to Touro, he declined treatment at the hospital and left without being evaluated by a physician, according to the police report.
But in a broader sense, Lewis, like many emotionally disturbed New Orleanians these days, ended up in jail because psychiatric services have all but collapsed since Hurricane Katrina.
Before the storm, police would have taken Lewis to an emergency unit for mental patients at Charity Hospital that dealt daily with the chronically mentally ill. Dr. Jeffrey Rouse, a psychiatrist with the Orleans Parish coroner's office, said the hospital police immediately took patients into custody. Although it is impossible to say what would have happened to Lewis, Rouse and others have said that Charity doctors routinely committed patients to a psychiatric bed if they were judged a threat to themselves or others.
Instead, Lewis is now held in Orleans Parish Prison on a charge of attempted first-degree murder, having been stopped short of killing his mother by a neighbor who heard the woman's cries and tackled her son. A relative who answered the door at the Lewis family's home declined to comment on the incident, saying only that Lewis' mother is still "very sick."
Touro declined to comment on the incident, citing Lewis' right to confidentiality.
More than a year and a half after Hurricane Katrina, Louisiana State University has not reopened a crisis intervention unit in the city. Indeed, hospital beds for the mentally ill are scarce throughout the region, while police say that their calls for service show the population in need of that care has returned to the city in significant numbers.

The lack of hospital beds, and the distances police must travel to find them, has spread law enforcement resources thin at a time when the NOPD is already strapped in trying to deal with rising crime. More and more mentally ill patients are winding up in jail, for lack of treatment options.

300 beds lost in N.O.

The dearth of resources for handling psychiatric patients extends through both the public and private sectors, which have lost a combined total of more than 300 psychiatric beds in New Orleans alone.
Touro mothballed its 48-bed psychiatric ward after the storm, largely due to pre-existing code-compliance issues and the pressing need to get medical and surgical services back online, according to CEO Leslie Hirsch. HCA, a national hospital chain, shut down the inpatient psychiatric unit at DePaul-Tulane Behavioral Health Center. Beds also were lost at the Methodist, Lakeland and Veterans Affairs hospitals, all of which flooded during Katrina and have not reopened.
Today the largest psychiatric facility in the region is at Orleans Parish Prison, with 60 acute-care beds.
Doctors say the demand for psychiatric beds has spiked even as the supply has plummeted. Katrina laid waste to mental health clinics and group homes, and the mental health of patients who found stability through those homes and clinics has deteriorated. Although some mental health clinics have since reopened, the patients most in need aren't aware of the services, frontline workers have said.
State agencies have taken limited steps to address the crisis. The Louisiana Office of Mental Health converted the New Orleans Adolescent Hospital into a facility for both adult and teenage psychiatric patients. Only 35 beds are open there, but the office has secured money to add 20 adult beds this year.
While the need for more hospital beds is critical, doctors say the safety net will not be whole until public or private agencies open more group homes, nursing homes or other centers where the mentally ill have continuous support.
"The thing about hospital beds is you only need them when your outpatient services have failed," said Dr. Kathleen Crapanzano, medical director of the Louisiana Office of Mental Health. "We do not have the services to prevent hospital visits."

Crisis unit gone

Despite months of talk about creating a new psychiatric emergency room, which police say is the most critical need in New Orleans, there are currently no plans to establish a crisis intervention unit to duplicate what Charity did before the storm. Charity used to be a safe haven, with its 100 psychiatric beds, its crisis intervention unit and doctors and nurses who knew many of the mental patients by name.
Instead, Louisiana State University has ordered up a modular unit where doctors can evaluate mental patients who would otherwise be brought to the emergency room at University Hospital, said Dr. Cathi Fontenot, medical director for both University and Charity hospitals. Although not the same as a crisis intervention unit, Fontenot said it would improve security and provide a "quieter place" for treating mental patients.
LSU also plans to lease a building on Calhoun Street, on the campus of the former DePaul Hospital, and open a psychiatric hospital with 33 beds this year. The hospital was supposed to include a crisis intervention unit, but LSU shelved those plans after neighbors protested this month.
Jim Arey, commander of the NOPD's crisis negotiation team, called the plans for a modular unit a start, saying that police would need a facility open 24 hours a day. "Charity took everybody we brought to them, day or night. The NOPD is looking for a replication of that," he said.
In March, the NOPD clocked 207 calls for help with a mentally disturbed person, compared with a police estimate of about 330 calls for assistance every month prior to the storm. Considering the decreased population in the city, the level of calls per capita has definitely increased.
Cecile Tebo, who as coordinator of their crisis unit helps NOPD officers get the mentally ill to a hospital, said that in the months immediately following Katrina she was seeing different types of people when the crisis unit went out on a call -- people who were depressed about the devastation and feeling hopeless about their lives.
But as more people returned to New Orleans, Tebo again saw the same severely mentally ill people she dealt with before the storm: schizophrenics trying to treat themselves with crack cocaine, people suffering from bipolar disorder, suicidal patients.
"I think if we don't do something soon, individuals will start getting hurt," Tebo said.
Local doctors confirm the return of full-blown psychotics to the city. Dr. Dean Hickman, vice chairman of psychiatry at Ochsner Medical Center, said family members who took them in after Katrina grow weary of their high-maintenance care, sometimes sending them back to old haunts with one-way bus tickets.
"There was one gentleman who went back into his flooded home," Hickman said. "He went and lived there until his behavior became so erratic that he came to the attention of the Police Department."
Doctors might steady such patients in the hospital, but Hickman said they often relapse because they do not connect with clinical services or continue taking medication once released.
Hickman and David Creger, a nurse at East Jefferson General Hospital, said a strong flow of drugs, especially cocaine, is helping to propel the mental health crisis. The drugs make mental patients more agitated, and they send new customers into the emergency rooms -- including many transient construction workers who combat loneliness by turning cash-filled pay envelopes into cocaine.
To address the problem, the Louisiana Office of Addictive Disorders plans this summer to open 20 detoxification beds at University Hospital and 30 more at Central Louisiana Hospital in Pineville where patients can receive care for both drug addiction and psychiatric illnesses.

New burdens on police

Without a centralized drop-off point for the mentally ill, police have resorted to establishing a rotation of hospitals where they can bring people in crisis. They must take patients to facilities with emergency rooms in case patients turn out to have medical as well as psychiatric problems, Arey said.
Officers can bring patients to three hospitals in New Orleans: Tulane University Hospital, University Hospital or Touro. Options in Jefferson Parish include West Jefferson Medical Center, East Jefferson General Hospital, and the Ochsner hospitals on both the east and west banks.
But unlike Charity, where police could drop off a patient and leave in about 15 minutes, -- the other hospitals require officers to stay with patients, Arey said. The average call for service for a mentally disturbed person takes about an hour.
"It is a public safety issue," said Arey, noting that officers baby-sitting mental patients in emergency rooms would be better deployed on the streets fighting crime.

Manipulative patients

At the hospitals, the police and their charges don't always get a welcome reception. And if patients indicate that they want to leave -- as Willie Lewis did -- they may be immediately released without evaluation, rather than confined to the psychiatric unit for observation as they once were at Charity, Tebo said.
And unlike Charity, the emergency rooms at private and community hospitals also lack security to handle the insane -- many of whom are violent or high on drugs. In separate incidents last week, two mental patients fled the emergency room at University Hospital while awaiting evaluation.
"We always have hospital police and extra nurses who are directly observing these patients, but the patients can be very talented at manipulating environments," Fontenot said. "If the nurses or police are distracted by other patients who require attention, it is easy for them to slip out and escape."
Dr. Joseph Guarisco, chairman of emergency medicine at Ochsner Medical Center, which has 12 inpatient psychiatric beds, said doctors would never release a patient they considered dangerous. But he said hospitals are forced to make difficult choices because resources are stretched.
"What we do in emergency medicine is assess risk," he said. "In an environment of reduced mental health capacity, we are having to make decisions we would not have made pre-Katrina, but we don't think we are putting the patient at risk. It may not be the best care, but we don't think it is risky."

Spending days in ER

When police deliver mental patients to emergency rooms, hospitals often struggle with where to send them. Inpatient psychiatric beds are scarce, and hospitals often end up boarding the patients in the ER for days until a bed opens up somewhere in the region -- or in another part of the state.
"It is a daily challenge," said Dr. Kevin Jordan, Touro's chief medical officer. "We get on the phone and start making calls. We have transferred folks as far as Alexandria or Baton Rouge."
Creger, the nurse at East Jefferson, said it can take four days to find a bed for a psychiatric patient who fetches up in his emergency room. But he said the wait is two to three times longer at hospitals without psychiatric units of their own. Patients idling in these emergency rooms are given medication and sometimes released if they start to improve.
With so few emergency resources, some relatives of the mentally ill have begun to seek help from the criminal justice system by having their relatives arrested.
Criminal District Court Judge Calvin Johnson said he has even suggested this remedy to people who call him asking for assistance. Johnson runs a mental health court, which currently includes about 65 defendants. They are provided counseling, medical assistance and help in kicking illegal drugs. But only certain defendants qualify for the program, and they must have been accused of a crime.
"There is only so much that the criminal justice system can do to solve this problem. It is not a problem for the criminal justice system to solve," Johnson said.
The 60 psych beds in Orleans Parish Prison are for inmates deemed a danger to themselves or others, said Dr. Michael Higgins, the prison's chief psychiatrist. Another 300 patients in the prison's general population are on some kind of medication and see the doctors and nurses on an "outpatient basis," he said.
Prisoners typically wait about a day and a half for a first appointment with a psychiatrist at OPP, Higgins said. "I can guarantee you that is much better than in the regular world," he said.
Altogether, the prison spends more than $9,000 a month on psychiatric medicine -- $108,731 from March 2006 until February 2007. That's about 20 percent of the jail's total pharmaceutical budget, Higgins said.
But prison mental health services don't always come through. Such was the case with Albert Davis, 52, who this month returned to prison after he did not get the mental health care he needed, according to one of his attorneys, Katherine Mattes of Tulane's criminal law clinic.
Davis was arrested in March 2006 for punching a police officer in the head. He was erratic during his arraignment in July, swearing and flipping over a table in the courtroom.
A court-appointed forensic psychologist in August labeled Davis "actively and grossly psychotic, delusionally paranoid and possibly manic" and recommended that he be declared incompetent and sent to the state's forensic hospital in Jackson.
Although Judge Frank Marullo ordered Davis to be transferred to Jackson, he remained in OPP until Mattes got his case. Because of an extensive statewide waiting list -- 164 as of last week, including 21 New Orleans inmates -- prisoners typically must wait to be transferred to the forensic hospital.
Mattes last month filed a petition to release Davis because he had been in prison for a year, double the maximum six-month sentence for battery of a police officer. Marullo ordered Davis released on April 3, but requested that he be put into hospital care, Mattes said.
Sheriff's deputies took Davis to University Hospital, but he was released in less than 24 hours, she said. By the time she called to check on him the next day, he was gone. He was arrested April 13 on municipal charges ranging from disturbing the peace to lewd conduct and battery and is now back at OPP.
"He's getting shuffled in and out of the criminal justice system because where he really needs to be is in a hospital," Mattes said, calling the new charges he faces reflective of his impaired mental condition. "This gentleman needs mental health care."

Laura Maggi can be reached at lmaggi@timespicayune.com or at (504) 826-3316. Kate Moran can be reached at kmoran@timespicayune.com or (504) 826-3491.